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Elevated amputation rates in COVID-19 survivors: Insights from a large-scale Japanese cohort study

Daisuke Miyamori1, Shuhei Yoshida1, Masanori Ito1

  • 1Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan.

Journal of Diabetes Investigation
|May 23, 2025
PubMed

Insights

COVID-19 survivors face a doubled risk of amputation, a complication that persists for over two years. This elevated risk is particularly pronounced in individuals with multiple underlying health conditions, underscoring the need for ongoing vascular monitoring.

Area of Science:

  • Vascular Medicine
  • Infectious Diseases
  • Epidemiology

Background:

  • COVID-19 is associated with vascular complications.
  • Long-term data on amputation risk following COVID-19 infection is limited.
  • Understanding post-COVID-19 vascular sequelae is crucial for patient management.

Purpose of the Study:

  • To evaluate the long-term risk of amputation in individuals after COVID-19 infection.
  • To assess the impact of COVID-19 on amputation rates using a large-scale Japanese health insurance database.
  • To identify factors influencing amputation risk in COVID-19 survivors.

Main Methods:

  • Retrospective cohort study utilizing the National Database of Health Insurance Claims and Specific Health Checkups of Japan.
  • Propensity score matching to create balanced cohorts of COVID-19 exposed and unexposed individuals.
  • Analysis of amputation incidence and calculation of incidence rate ratios (IRRs) and differences (IRDs) with sensitivity and subgroup analyses.

Main Results:

  • Over 3 million matched pairs were analyzed, with a median follow-up of 7 months.
  • COVID-19 survivors exhibited a 2.33-fold increased risk of amputation (IRR 2.33; 95% CI 1.88-2.90).
  • Elevated amputation risk persisted beyond 2 years post-infection and was significantly higher in those with a greater comorbidity burden (Charlson Comorbidity Index ≥2).

Conclusions:

  • COVID-19 infection is linked to a sustained increase in amputation rates among survivors.
  • The heightened risk of amputation post-COVID-19 is exacerbated by the presence of multiple comorbidities.
  • Long-term monitoring and proactive management of vascular complications are essential for COVID-19 survivors, especially those with pre-existing health conditions.
Abstract

Keywords:
AmputationCOVID‐19National Insurance Claims Database

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